HISTORY AND EVOLUTION OF DSM

HISTORY

An official U.S. classification for mental disorders was attempted only recently.
The 1840 census classified all mental illness in a single category, “Idiocy.” This
early attempt was expanded in the 1880 census, in which seven mental disorder
categories were listed: mania, melancholia, monomania, paresis, dementia,
dyssomnia, and epilepsy (APA, DSM-IV, 1994). By the late 1920s, almost every
medical teaching center used a different classification system for mental
disorders. The result was a diverse nomenclature that often led to meaningless
communications and arguments between professionals.

The 1933 Standard Classified Nomenclature of Disease (SCND), which

addressed severe neurological and psychiatric disorders, attempted to bring
order to the terminology. This nomenclature functioned reasonably well until a
crisis in psychiatric terminology was sparked by symptoms seen in World War II
veterans. Only 10% of the
Total cases seen by military psychiatrists could be classified using the SCND
(APA, DSM, 1952). In addition, during the postwar period, three separate U.S.
nomenclature existed (the SCND, and those of the Armed Forces and the
Veterans Administration system). None of these nomenclatures was consistent
with the ICD.

DSM-I

As a result of the aforementioned confusion over terminology, the APAS’s

Committee on Nomenclature and Statistics proposed a revised classification
system. After much deliberation, the first Diagnostic and Statistical Manual of
Mental Disorders (DSM) was published in 1952. The manual was later called
DSM-I when it became apparent that revisions were needed. DSM-I was
reprinted 20 times, was distributed widely, and did much to stabilize mental
health nomenclature.

DSM-II

DSM-II was the result of an international collaborative effort that also

culminated in the mental disorders section in the eighth revision of the
International Classification of Diseases (ICD-8). Both DSM-II and ICD-8 went into
effect in 1968.
DSM-III

Work on DSM-III began in 1974, in anticipation of ICD-9’s 1979

scheduled publication date. Unfortunately, the mental disorders section proposed
for ICD-9 was bit sufficiently detailed for research and clinical work, so the APA
Task Force on Nomenclature and Statistics developed a new classification
system. The development process was complicate and included 14 advisory
committees, consultants from allied fields, liaison committees with professional
organizations, conferences and field trials. The field trials included tests of
diagnostic reliability, the results of which were published in appendix F, DSM-III
was a dramatic departure from previous DSMs. Innovations included

Definition of the term mental disorder

Presentation of diagnostic criteria for each disorder
Diagnosis according to a multiaxial evaluation system
Redefinition of major disorders
Addition of new diagnostic categories
Hierarchical organization of diagnostic categories
Systematic description of each disorder
Decision trees for differential diagnosis
Glossary of technical terms
Annotated comparative listing of DSM-II and DSM-III
Discussion of ICD-9 and ICD-9-CM
Publication of reliability data from field trials
Indices of diagnostic terms and symptoms

DSM-III-R

DSM-III-R’s development and stated goals were similar to those of DSM-

III. Twenty-six advisory committees were formed, each with membership based
on expertise in a particular area. In addition, the experience gained in using the
DSM-III diagnostic criteria, particularly in well-conducted research studies, played
a significant role in proposed modifications. Two draft proposals of DSM-III-R
were made available for critical review, and field trials were conducted. New
appendices were added to DSM-III-R; they included proposed diagnostic
categories needing further study (e.g., late luteal phase dysphoric disorder,
sadistic personality disorder, and self-defeating personality disorder), an
alphabetic listing of DSM-III-R diagnoses and codes, a numerical listing of DSM-
III-R diagnoses and codes, and an index of selected symptoms

DSM-IV

In 1988, only one year after DSM-III-R’s publication, the APA formed a
Task Force to revise DSM-III-R. The Task Force’s purpose was to keep DSM
diagnostic codes and terminology compatible with ICD-10, scheduled for
publication in 1993 (actually published in 1992).
 The 27-member Task Force on DSM-IV organized 13 work groups. Each
work group, in collaboration with many expert advisers, was then responsible for
developing certain sections of DSM-IV. In addition to conducting extensive
literature reviews, these work groups reanalyzed existing data and performed
numerous field trials to answer important issues regarding diagnoses and
diagnostic criteria. (Note: The five-volume DSM-IV Sourcebook [APA, 1994 and
in press] contains consolidated literature reviews, report on data reanalyzed and
field trials, as well as rationale for Work Group decisions.)

The following will discuss specific changes to DSM-III-R that are found in
the new edition. The major changes in DSM-IV include

• Axis IV is now used to list psychosocial and environmental problems that

influence diagnosis, treatment, and prognosis (DSM-III-R Severity of
Psychosocial Stressors Scales were eliminated).

• Specific learning disorders, Motor skills Disorders, Communications

Disorders, and Pervasive Developmental Disorders are listed on Axis I.

• Types of information presented for each disorder have changed. Additions

include subtypes and/or specifiers, recording procedures, associated
laboratory findings, associated physical examination findings, specific
cultural features, and course.
• The term organic was eliminated

• DSM-III-R’s Organic Mental Syndromes and Disorders were separated

into three sections: (1)” Delirium, Dementia, and Amnestic and Other
Cognitive Disorders,” (2) “Mental Disorders Due to a General Medical
Condition,” and (3) “Substance-Related Disorders.”

• In addition, certain Substance-Induced Disorders were relocated in

sections with similar phenomenology (e.g., Substance-Induced Anxiety
Disorders is located in the “Anxiety Disorders” section).

• Thirteen disorders with diagnostic criteria were added; 56 new substance-

Related Disorders are listed.

• Eight disorders were eliminated.

• Appendix B, “Criteria Sets and Axes Provided for Further Study,” was
expanded from 3 to 26

• Appendix G is new; it lists ICD-9-CM codes of selected medical diagnoses

and medications.
 • Appendix I was added: “Outline for Cultural Formulation and Glossary of
Culture-Bound Syndromes

• The Symptom Index was eliminated.

Source: Reid, William H. & Wise, Michael G. (1995). DSM-IV Training Guide.
New York: Brunner/Mazel, Inc.

DSM-V

Released and published in May 2013, the current version of

the manual is surrounded with a lot of controversies concerning its
revisions. Refer to the following cites for more information:

Allen J. Frances on the overdiagnosis of mental illness

https://www.youtube.com/watch?feature=player_embedded&v=yuCw
VnzSjWA

DSM5 in Distress
The DSM's impact on mental health practice and research
by Allen Frances, M.D.
http://www.psychologytoday.com/blog/dsm5-in-distress
 INTERNATIONAL CLASSIFICATION of DISEASES (ICD)

The First Revision Conference of the International List of Causes of Death

was held in Paris in 1900. Since the first ICD, which was used strictly for the
coding of causes of death, revisions have been made about every 10 years. The
ICD did not provide a separate section for mental disorders until the fifth revision
(1938); later revision expanded the classification system to include causes for
morbidity. The 1978 revision, ICD-9 was modified for use in the United States for
collection of morbidity data, collecting research data, indexing medical records,
reviewing cases, and for administrative purposes. This modification, called ICD-
9-CM (Clinical Modification), was published in 1979 by the U.S. Department of
Health Services. The latest ICD revision, ICD-10, was published in 1992; its
official use in the United States is not expected for several years.

Because of close collaboration, DSM codes and terms are fully compatible
with ICD codes.

Source: Reid, William H. & Wise, Michael G. (1995). DSM-IV Training Guide.
New York: Brunner/Mazel, Inc.